Provider Demographics
NPI:1346739141
Name:HATHAWAY, TEMEKA SHAVONNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TEMEKA
Middle Name:SHAVONNE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 FAIRVIEW DR STE B
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1206
Practice Address - Country:US
Practice Address - Phone:757-562-2158
Practice Address - Fax:757-516-8019
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily